Under dyspepsia is defined as a feeling of pain or paresthesia in the upper abdomen; often it is of recurrent nature. It can serve as dyspepsia, early satiety, postprandial bloating and gnawing or burning pain are described. Etiology There are various causes of dyspepsia (see Table: Causes of indigestion). Causes of dyspepsia cause suspicious findings Diagnostic procedure achalasia slowly progressive dysphagia Early satiety, nausea, vomiting, bloating and symptoms that are worsened by food Sometimes nocturnal regurgitation of undigested food chest discomfort barium swallow Esophageal endoscopy cancer (z. B. esophagus, stomach ) Chronic, vague symptoms later dysphagia (esophagus) or early satiety (stomach) Ge weight loss Upper endoscopy coronary ischemia in some patients have symptoms such as gas or indigestion instead of chest pain described if necessary Load component Cardiac risk factors ECG Cardiac serum parameters Sometimes stress tests Delayed gastric emptying (caused by diabetes, viral illness or medication) nausea, flatulence, bloating Szintigrafischer Test of gastric emptying drugs (z. B. bisphosphonates, erythromycin, and other macrolide antibiotics, estrogens, iron, NSAIDs, potassium) use obviously consistent with clinical indications for use based on history symptoms clarification esophageal spasm Substernal chest pain with or without dysphagia Gastroesophageal regarding liquids and solids barium swallow Esophageal Reflux Disease Heartburn Sometimes reflux of acid or stomach contents into the mouth symptoms are sometimes triggered by lying down improvement in administration of antacids Clinical examination if necessary If necessary, endoscopy 24-hour pH monitoring Peptic ulcer disease Burning or gnawing pain mend under fed or Antazidagabe Upper endoscopy Many patients show examination findings (z. B. duodenitis, disorders of Pylorusfunktion, motility disorders, Helicobacter pylori gastritis, lactase deficiency cholelithiasis), the only little correlate with the symptoms (as the elimination of the evidence does not lead to improvement of dyspepsia). The nichtulzeröse (functional) dyspepsia is defined as gastric disorders in a patient having no abnormalities at the physical examination and endoscopy of the upper gastrointestinal tract. Clarification History A history of existing disease should be a clear description of symptoms including information as to whether they are acute or chronic and relapsing, included. Other elements are time and frequency of recurrence, difficulty swallowing, and the relationship of symptoms to food or medication. Factors that exacerbate symptoms (especially effort, certain foods or alcohol) or ease (especially eating or taking antacids) are noted. An examination of the body systems to give about accompanying gastrointestinal symptoms such as loss of appetite, nausea, vomiting, hematemesis, weight loss and bloody or black (melanotic) chair digestion. Other symptoms include shortness of breath and sweating. The history should (z. B., hypertension hypercholesterolemia) involve known gastrointestinal and cardiac diagnostics, cardiac risk factors and the results of all previously completed tests and previous treatment attempts. A drug history includes prescription medications, illegal drug use and Alkoholmissbrauch.Körperliche investigation In the investigation of vital signs, make a tachycardia or an irregular pulse. A general examination should note symptoms such as pallor or sweating, cachexia or jaundice. The abdomen is scanned on tenderness, masses and organ enlargement. A rectal exam is performed to visible or occult blood nachzuweisen.Warnhinweise The following findings are of particular significance: Acute episodes of shortness of breath, sweating or tachycardia anorexia nausea and vomiting weight loss blood in the stool dysphagia or odynophagia Missing response to treatment with H2 blockers or proton pump inhibitors (PPIs) interpretation of results Some results are helpful (see table: causes of indigestion). Concern a single, acute episode of dyspepsia in a patient is especially when the symptoms of shortness of breath, sweating, tachycardia or be accompanied; Such patients may have an acute coronary ischemia. Chronic symptoms that occur during physical activity and make amends at rest may indicate pectoris angina. Gastrointestinal causes manifest themselves most likely to chronic ailments. The symptoms are sometimes called ulcer, reflux dysmotilitäts- or similar; by making such classifications, but show no etiology. Ulkusähnliche symptoms include upper abdominal pain that often occur before meals and be alleviated with food intake, Antazida- or H2 blockers administration in part. Dysmotilitätsähnliche symptoms consist of more discomfort than from pain, along with early satiety, postprandial fullness, nausea, vomiting and bloating; the symptoms can be exacerbated by food intake. Reflux-like symptoms are heartburn and acid reflux. All of these symptoms often occur overlapping. The alternation between diarrhea and constipation in dyspepsia puts the suspicion of irritable bowel syndrome or excessive use of over the counter laxatives or antidiarrheals nahe.Tests patients in whom the symptoms are indicative of acute coronary ischemia, especially those with risk factors should for an urgent clarification in the emergency room to be sent, including ECG and cardiac serum markers. In patients with chronic, non-specific symptoms are a routine investigations, a total blood count (to exclude caused by gastrointestinal blood loss anemia) and the usual blood tests. If the findings are abnormal, further investigations are initiated (imaging, endoscopy). Because there is a risk of a cancer patient should be investigated endoscopically> 55 years, and those in which the alarm symptoms come into being. recommended for patients <55 years without alarm symptoms, some specialists empirical therapy for 2-4 weeks with anti-secretory substances and under treatment failure endoscopy. Others recommend a Sreening to infection with H. pylori with the C14-urea breath test or stool test (Helicobacter pylori infection: Non-invasive testing procedures). However, care should be taken to refer to H. pylori or other non-specific findings to explain the symptoms. Esophageal manometry and pH analyzes are indicated if reflux symptoms still persist after the endoscopy of the upper GIT, and after a two- to four-week treatment experiment with proton pump inhibitors. Specific findings therapy are treated. Patients in whom objective findings could not be identified, are monitored and reassured. Symptoms are treated with proton pump inhibitors, H2-blockers or cytoprotective agents (see table: Some oral medicines for indigestion). Prokinetic drugs (eg., Metoclopramide, erythromycin) can be used with dysmotilitätsähnlicher dyspepsia as a suspension in patients. However, there is no clear evidence that the gift of a right, the symptom (reflux vs. dysmotility) really makes appropriate drug in the treatment of a difference. Misoprostol and anticholinergics are not effective in functional dyspepsia. Drugs that alter the sensory perception (z. B. tricyclic antidepressants) may be helpful. Some oral medicines for dyspepsia drug Usual dose Comments proton pump inhibitors dexlansoprazole 30 mg once daily. A long-term use leads to increased Gastrinspiegeln, there are however no evidence that this finding leads to dysplasia or cancer Can abdominal pain or diarrhea cause esomeprazole 40 mg once daily.Lansoprazole 30 mg once daily. Omeprazole 20 mg once daily. Pantoprazole 40 mg once daily. Rabeprazole 20 mg once daily. H2Blocker cimetidine 800 mg once daily. In older patients, reduced dose cimetidine and to a lesser extent other drugs have a low anti-androgen activity and are more rarely associated with erectile dysfunction Delayed metabolism of medicinal products (by the cytochrome P-450 enzyme system z. eliminated as phenytoin, warfarin, diazepam) Can constipation or diarrhea cause famotidine 40 mg once daily. nizatidine 300 mg once daily. ranitidine 300 mg once daily. or 150 mg 2 times daily. Cell Protection Factor sucralfate 1 g orally 4 times daily. rarely constipation can bind to other drugs and interfe with their absorption Center. Cimetidine, ciprofloxacin, digoxin, norfloxacin, ofloxacin and ranitidine should be avoided two hours before or after taking sucralfate Key points A coronary ischemia may be with a patient with acute "gas" before. Endoscopy is indicated for patients> 55 years or with suspicious findings. An empirical treatment with an acid blocker is useful for patients <55 years with no suspicious findings; in patients who do not respond within 2-4 weeks on the therapy, further tests are needed.